Evaluating Myotomy Length in POEM for Achalasia: A Grade-Assessed Meta-Analysis of Randomized Controlled Trials.

Background: Peroral endoscopic myotomy (POEM) is a standard achalasia treatment, matching surgery in efficacy. However, myotomy length varies. Shorter myotomies are gaining attention for potential benefits.

Aggressive management and liver transplantation in Budd-Chiari syndrome secondary to Behçet's disease.

Budd-Chiari Syndrome (BCS) is a rare vascular disorder caused by hepatic venous outflow obstruction, often due to thrombosis, leading to liver congestion and portal hypertension. Behçet's Disease (BD), a chronic vasculitis, can cause BCS through inflammation-induced thrombosis. We report a 14-year-old male with BD who developed BCS.

EXPRESS: Two Decades of Inflammatory Bowel Disease-Related Cardiovascular Mortality in the United States: Temporal Trends and Demographic Disparities from a National Death Registry.

Although the association between inflammatory bowel disease (IBD) and cardiovascular disease (CVD) is well established, long-term, population-level trends in cardiovascular mortality among individuals with IBD remain poorly characterized. This study provides a comprehensive, nationwide analysis of IBD-associated cardiovascular mortality in the United States over a two-decade period, emphasizing temporal patterns and sociodemographic disparities. We performed a retrospective analysis using the CDC WONDER database from 1999 to 2020, identifying decedents with CVD (ICD-10 I00-I99) as the underlying cause and IBD (ICD-10 K50/K51) as a contributing condition.

Comparative Effectiveness of Bariatric Surgery Versus GLP-1 Receptor Agonists in Reducing the Risk of New-Onset of NASH: A Retrospective Multinational Cohort Study From North America and Europe.

Background: Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD) that can progress to cirrhosis and hepatocellular carcinoma (HCC). Obesity is a major risk factor for NASH, and metabolic interventions such as bariatric surgery (BS) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have been explored for their impact on liver-related outcomes. This study evaluates the comparative effectiveness of BS and GLP-1 RAs in reducing the incidence of new-onset NASH and related hepatic complications.

Do Patients With Acute Coronary Syndrome Face Higher Mortality on Weekends Versus Weekdays? A Comprehensive Analysis of Demographic, Geographic, and Temporal Trends in the United States.

Background: The impact of a "weekend effect" on US acute coronary syndrome (ACS) mortality remains uncertain. We compared weekend and weekday age-adjusted mortality rates (AAMRs) and analyzed demographic, geographic, and temporal trends from 1999 to 2020.

Methods: We conducted a national analysis of ACS deaths (age ≥ 25 years) using CDC WONDER (ICD-10: I20.

A Blind Spot in Imaging: Immune Checkpoint Inhibitor-Induced Myocarditis with Negative Cardiac MRI.

Immune checkpoint inhibitor (ICI)-induced myocarditis is rare but carries a high morbidity and mortality rate. While cardiac magnetic resonance imaging (CMR) is the first-line imaging modality to support diagnosis, the need for endomyocardial biopsy is needed in negative CMR cases.

Metabolic Dysfunction-Associated Steatotic Liver Disease as a Cardiovascular Risk Factor: Focus on Atrial Fibrillation.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, is increasingly recognized as a multisystem disorder with significant cardiovascular implications, particularly in its association with atrial fibrillation (AF). As the most common sustained cardiac arrhythmia, AF contributes to substantial morbidity and mortality, making it essential to explore its links with MASLD. The relationship between these conditions is underpinned by shared pathophysiological mechanisms, including systemic inflammation, insulin resistance, oxidative stress, and activation of the renin-angiotensin-aldosterone system.

Duplicated Inferior Vena Cava: A Rare Anatomical Variation.

The inferior vena cava is a crucial venous structure that originates during the first trimester of gestation. Anomalies in its development can lead to rare conditions, including duplication of the inferior vena cava (DIVC). This case report describes a 26-year-old male with no significant medical history who presented with acute dysphagia after consuming a large piece of chicken.

Diagnosing late-onset PKU in the shadow of refractory seizures.

Phenylketonuria (PKU), a rare autosomal recessive metabolic disorder, often presents with severe neurological complications if untreated, but late diagnosis can mimic other conditions such as Febrile Infection-Related Epilepsy Syndrome (FIRES). This report discusses a 10-year-old male initially misdiagnosed with FIRES, whose refractory seizures and encephalopathy prompted further genetic investigation. Whole-exome sequencing revealed compound heterozygous mutations in the PAH gene, confirming late-diagnosed PKU.

Catastrophic antiphospholipid syndrome presenting with a stroke as a first presentation: case report.

Catastrophic Antiphospholipid Syndrome (CAPS), an autoimmune disease that causes multi-organ thromboses leading to their failure, is a rapidly developing form of antiphospholipid syndrome (APS). APS may be a primary disease or secondary to an autoimmune condition like Systemic Lupus Erythematosus (SLE). A 31-year-old male patient with unremarkable medical history presented with a sudden onset of left-sided body weakness including upper and lower extremities, frontal headache, and slurred speech.

Hyperuricemia and Cardiovascular Risk: Insights and Implications.

Hyperuricemia, characterized by elevated serum uric acid levels, has been linked to cardiovascular diseases such as hypertension, atrial fibrillation, chronic kidney disease, heart failure, metabolic syndrome, and coronary artery disease. This relationship, however, is complex; while some studies indicate a strong association, others suggest that it may be influenced by confounding factors. The rising global prevalence of hyperuricemia underscores the necessity for a deeper understanding of its cardiovascular implications.

Recurrent fixation failure of a distal femur fracture associated with intellectual disability: A case report.

Introduction And Importance: Distal femur fractures, particularly in patients with intellectual disabilities, pose unique challenges due to factors such as non-compliance with postoperative instructions and recurrent fixation failures. These complications necessitate multiple surgical interventions, increasing morbidity and disability.

Case Presentation: A 59-year-old female with intellectual disability and comorbid diabetes and hypertension sustained a distal femur fracture.

Behçet's disease and factor V Leiden: A thrombogenic synergy causing budd-chiari syndrome.

Behçet's Disease (BD) is a multisystem inflammatory disorder that can lead to severe vascular complications, including Budd-Chiari Syndrome (BCS), a rare but life-threatening condition characterized by hepatic vein obstruction. The co-occurrence of BD and inherited thrombophilia, such as Factor V Leiden mutation, significantly increases the risk of thrombosis, complicating the clinical management of affected individuals. In this case, a 16-year-old female initially presented with nonspecific symptoms of generalized fatigue and bone pain, which later progressed to abdominal distension and significant hepatosplenomegaly.

Incidental finding of hepatic pseudolesion from aberrant right gastric vein in a breast cancer patient.

Aberrant right gastric veins (ARGV) represent rare anatomical variations that can result in hepatic pseudolesions, mimicking malignancies due to their atypical drainage directly into the liver parenchyma. This case highlights a 44-year-old woman initially presenting with a breast mass incidentally found to have an ARGV-related pseudolesion in hepatic segment IVa. ARGV is clinically significant as it can alter hepatic blood flow dynamics, leading to hyperdense or hypodense regions on imaging.

First recorded isolation of in a nonendemic setting.

Nontuberculous mycobacteria (NTM) are a diverse group of environmental mycobacteria found ubiquitously in soil and water, causing infections that typically arise from environmental exposure rather than person-to-person transmission. This case report documents the first known detection of in our region, emphasizing the clinical challenges and diagnostic complexities associated with NTM infections. The case involves a 37-year-old male with a significant smoking history who presented with progressively worsening cough, significant weight loss, and bilateral cavitary lung lesions.

Targetoid skin lesions in a newborn: a case of erythema multiforme.

Erythema multiforme (EM) is an immune-mediated condition that manifests as targetoid skin lesions and can be triggered by various factors, including infections and vaccinations. This case report describes a 41-day-old full-term male infant who developed widespread annular, bullseye-shaped erythematous skin lesions one week after receiving the Bacillus Calmette-Guérin (BCG) vaccination. The infant, exclusively breastfed and without a significant past medical history, presented with these lesions but no associated systemic symptoms.

The subtle scaphoid fracture in childhood: A case report with literature insights.

We describe a 9-year-old male who suffered a linear, non-displaced scaphoid fracture following a pedestrian motor vehicle accident. Initially, X-ray imaging failed to detect the fracture, but MRI confirmed the diagnosis, highlighting the challenges in identifying scaphoid fractures in pediatric patients due to the bone's cartilaginous nature in this age group. The patient was treated with immobilization using a Plaster of Paris cast, consistent with standard management for non-displaced fractures in children.

Mixed connective tissue disease: A case of aggressive progression and multisystem involvement.

Mixed connective tissue disease (MCTD) is a rare autoimmune syndrome characterized by overlapping features of systemic sclerosis, systemic lupus erythematosus (SLE), and polymyositis, first described by Sharp et al. in 1972. This case report discusses a 38-year-old female who presented with symptoms indicative of these overlapping conditions, including sclerodactyly, Raynaud's phenomenon, and muscle weakness, confirmed by laboratory findings and imaging.

Unveiling postpartum pituitary apoplexy through atypical presentation: A case report and review of literature.

Our case details the atypical presentation of postpartum pituitary apoplexy in a 20-year-old female, who exhibited general weakness, dizziness, and brief loss of consciousness following an uncomplicated vaginal delivery. Despite normal vital signs except for bradycardia, imaging revealed a pituitary hemorrhage, leading to the diagnosis of pituitary apoplexy. Managed conservatively with IV hydrocortisone and intensive care, the patient experienced persistent bradycardia and severe abdominal pain, requiring transfer to another ICU.

Dramatic devastative complications in a patient with catastrophic antiphospholipid syndrome: A Case report and literature review.

Catastrophic antiphospholipid syndrome (CAPS) is a very severe form of the classic antiphospholipid syndrome (APS). Although CAPS occurs in less than 1% of all patients with APS, it is considered a life-threatening condition. This report highlights an interesting case of a 45-year-old male diagnosed with CAPS.

Spontaneous splenic rupture as a primary manifestation of angiosarcoma: a case report.

Angiosarcoma, a rare endothelial cell tumor, accounts for < 2% of all sarcomas, typically affecting elderly patients. We present the case of a 62-year-old male with a history of hypertension and ischemic heart disease, who initially presented with severe lower back pain. Subsequent imaging revealed a ruptured splenic lesion and multiple liver lesions, leading to a diagnosis of stage 4 angiosarcoma.

Adenocarcinoma of the appendix presenting as chronic small bowel obstruction: A case report.

Appendiceal carcinoma, a rare malignancy comprising less than 1% of gastrointestinal cancers, often presents diagnostic challenges due to its atypical symptoms. This report details a 68-year-old female with a history of severe anemia, gastrointestinal bleeding, and persistent abdominal symptoms, ultimately diagnosed with chronic small bowel obstruction caused by an appendiceal adenocarcinoma. Despite initial treatment for Helicobacter pylori-induced gastritis, her symptoms persisted, prompting further imaging that revealed a narrowed small bowel segment.

Cohen Syndrome With Complex Medical Complications: A Case Report.

Cohen syndrome (CS) is a rare autosomal recessive disorder marked by developmental delays, distinct facial features, and a variety of systemic manifestations. We present a case of a 28-year-old male previously misdiagnosed with Prader-Willi syndrome who exhibited recurrent generalized weakness, fever, fatigue, and significant hemoglobin drops requiring multiple blood transfusions due to thalassemia major. The patient displayed characteristic CS features, including developmental delays, distinct facial characteristics, morbid obesity, and heterochromia iridis.